Malignant lung PEComa (clear cell tumor): rare case report and literature review.

Clear cell tumors of the lung (CCTL), or "sugar tumors" of lung, are very uncommon lesions and are mostly benign perivascular epithelioid cell (PEC) tumors with no specific morphologic features. Fewer than 100 cases have been reported; the aggressive nature demonstrated in sporadic reports has rarely been described in the literature. Although the course is generally described as benign, eight reported cases showed malignant behavior. We report a case of a PEC with a malignant presentation in a young man, correlating the main characteristics of the tumor with other cases reported in the literature to better elucidate this rare presentation. We also performed a literature review of reports on benign and malignant CCTL cases, with a focus on clinical, imaging, and immunohistochemical differentiation. CCTLs are rare tumors that require histopathological and immunohistochemical confirmation; to date, criteria that can predict malignant evolution are lacking.

ANCA-associated glomerulonephritis and lupus nephritis following COVID-19 vaccination: a case report and literature review.

With the coverage of COVID-19 vaccination, it has been possible to observe the potential side effects of SARS-CoV-2 vaccines, with the most common ones being fever, myalgia, headache, and fatigue. However, an association has been observed between new and recurrent kidney injuries, mainly glomerulonephritis and lupus nephritis associated with ANCA, with the Pfizer-BioNTech, Moderna, Sinovac, and AstraZeneca vaccines, although the relationship between them is not clear. We report a case of ANCA-related vasculitis and lupus glomerulonephritis after the second dose of the AstraZeneca vaccine. The elderly patient presented significant worsening of kidney function after immunosuppression and complications after a new onset COVID-19 infection that led to death. We provide a literature review about kidney damage related to ANCA vasculitis after COVID-19 vaccine, aiming for a better understanding of the pathophysiological mechanism of kidney injury, its presentation, and treatment.

Spirituality and religiosity expressed by relatives of drug users: contributions to health care.

OBJECTIVE: to analyze the expressions of spirituality and religiosity of relatives of people who abuse or are dependent on psychoactive substances. METHODS: exploratory-descriptive research that dialogues with the spirituality and religiosity conceptual framework. It was performed at an outpatient clinic specialized in drug treatment in southern Brazil. Semi-structured interviews conducted with 11 relatives of patients undergoing treatment were analyzed by content analysis. RESULTS: the findings were grouped into two categories: forms of expression of spirituality and religiosity practices; and their influence on relatives' lives. Spirituality and religiosity almost always serve as a protective factor against feelings of anguish, conflicts and loneliness. FINAL CONSIDERATIONS: despite the important role of expressions of spirituality and religiosity for many relatives, not everyone seems to benefit from them. Health professionals should consider these expressions in the construction of comprehensive health care for relatives.

Quantum Biochemistry Screening and In Vitro Evaluation of Leishmania Metalloproteinase Inhibitors.

Leishmanolysin, also known as major promastigote protease (PSP) or gp63, is the most abundant surface glycoprotein of Leishmania spp., and has been extensively studied and recognized as the main parasite virulence factor. Characterized as a metalloprotease, gp63 can be powerfully inactivated in the presence of a metal chelator. In this study, we first used the structural parameters of a 7-hydroxycoumarin derivative, L1 compound, to evaluate the theoretical-computational experiments against gp63, comparing it with an available metal chelator already described. The methodology followed was (i) analysis of the three-dimensional structure of gp63 as well as its active site, and searching the literature and molecular databases for possible inhibitors; (ii) molecular docking simulations and investigation of the interactions in the generated protein-ligand complexes; and (iii) the individual energy of the gp63 amino acids that interacted most with the ligands of interest was quantified by ab initio calculations using Molecular Fraction with Conjugated Caps (MFCC). MFCC still allowed the final quantum balance calculations of the protein interaction to be obtained with each inhibitor candidate binder. L1 obtained the best energy quantum balance result with -2 eV, followed by DETC (-1.4 eV), doxycycline (-1.3 eV), and 4-terpineol (-0.6 eV), and showed evidence of covalent binding in the enzyme active site. In vitro experiments confirmed L1 as highly effective against L. amazonensis parasites. The compound also exhibited a low cytotoxicity profile against mammalian RAW and 3T3 cells lines, presenting a selective index of 149.19 and 380.64 µM, respectively. L1 induced promastigote forms' death by necrosis and the ultrastructural analysis revealed disruption in membrane integrity. Furthermore, leakage of the contents and destruction of the parasite were confirmed by Spectroscopy Dispersion analysis. These results together suggested L1 has a potential effect against L. amazonensis, the etiologic agent of diffuse leishmaniasis, and the only one that currently does not have a satisfactory treatment.

Convective drying of mango enriched with phenolic compounds from grape residue flour under different impregnation methods.

This work evaluated the effect of convective drying of mango impregnated with grape residue flour polyphenols under different vacuum impregnation methods with or without performing osmotic treatment and ultrasound on the global quality of dried mango in relation to chemical, microbiological and sensory aspects. Higher retention of carotenoids, phenolic compounds, and ascorbic acid was obtained with shorter drying times and lower oxygen exposure. Impregnated dried samples submitted to ultrasound-assisted vacuum impregnation showed a higher drying rate, greater retention of carotenoids (6.77 µg/g DM), and softer samples. Greater retention of phenolic compounds (1.84 mg GAE/g DM) was obtained for osmotic dehydration-assisted vacuum impregnation dried mango, while osmosonication-assisted impregnation was able to retain the highest ascorbic acid content (7.05 mg/100 g DM). Sensory evaluation showed that the impregnated samples showed good acceptance. The combination of osmotic dehydration and ultrasound could be a suitable way to produce dried mango impregnated with grape residue polyphenols.

Identification of 1,2,3-triazole-phthalimide derivatives as potential drugs against COVID-19: a virtual screening, docking and molecular dynamic study.

In this work we aimed to perform an in silico predictive screening, docking and molecular dynamic study to identify 1,2,3-triazole-phthalimide derivatives as drug candidates against SARS-CoV-2. The in silico prediction of pharmacokinetic and toxicological properties of hundred one 1,2,3-triazole-phtalimide derivatives, obtained from SciFinder® library, were investigated. Compounds that did not show good gastrointestinal absorption, violated the Lipinski's rules, proved to be positive for the AMES test, and showed to be hepatotoxic or immunotoxic in our ADMET analysis, were filtered out of our study. The hit compounds were further subjected to molecular docking on SARS-CoV-2 target proteins. The ADMET analysis revealed that 43 derivatives violated the Lipinski's rules and 51 other compounds showed to be positive for the toxicity test. Seven 1,2,3-triazole-phthalimide derivatives (A7, A8, B05, E35, E38, E39, and E40) were selected for molecular docking and MFCC-ab initio analysis. The results of molecular docking pointed the derivative E40 as a promising compound interacting with multiple target proteins of SARS-CoV-2. The complex E40-Mpro was found to have minimum binding energy of -10.26 kcal/mol and a general energy balance, calculated by the quantum mechanical analysis, of -8.63 eV. MD simulation and MMGBSA calculations confirmed that the derivatives E38 and E40 have high binding energies of -63.47 ± 3 and -63.31 ± 7 kcal/mol against SARS-CoV-2 main protease. In addition, the derivative E40 exhibited excellent interaction values and inhibitory potential against SAR-Cov-2 main protease and viral nucleocapsid proteins, suggesting this derivative as a potent antiviral for the treatment and/or prophylaxis of COVID-19.Communicated by Ramaswamy H. Sarma.

Spirituality and religiosity expressed by relatives of drug users: contributions to health care / Espiritualidad y religiosidad expresada por familiares de usuarios de drogas: aportes al cuidado de la salud / Espiritualidade e religiosidade expressas por familiares de usuários de drogas: contribuições ao cuidado em saúde

ABSTRACT Objective: to analyze the expressions of spirituality and religiosity of relatives of people who abuse or are dependent on psychoactive substances. Methods: exploratory-descriptive research that dialogues with the spirituality and religiosity conceptual framework. It was performed at an outpatient clinic specialized in drug treatment in southern Brazil. Semi-structured interviews conducted with 11 relatives of patients undergoing treatment were analyzed by content analysis. Results: the findings were grouped into two categories: forms of expression of spirituality and religiosity practices; and their influence on relatives' lives. Spirituality and religiosity almost always serve as a protective factor against feelings of anguish, conflicts and loneliness. Final considerations: despite the important role of expressions of spirituality and religiosity for many relatives, not everyone seems to benefit from them. Health professionals should consider these expressions in the construction of comprehensive health care for relatives.

RESUMEN Objetivo: analizar las expresiones de espiritualidad y religiosidad de familiares de personas que abusan o son dependientes de sustancias psicoactivas. Métodos: investigación exploratoria-descriptiva que dialoga con el marco conceptual de la espiritualidad y la religiosidad. Fue realizado en un ambulatorio especializado en tratamiento de drogas en el sur de Brasil. Se analizaron mediante análisis de contenido entrevistas semiestructuradas realizadas a 11 familiares de pacientes en tratamiento. Resultados: los hallazgos fueron agrupados en dos categorías: formas de expresión de la espiritualidad y prácticas de religiosidad; y su influencia en la vida de los familiares. La espiritualidad y la religiosidad sirven casi siempre como factor protector contra los sentimientos de angustia, conflictos y soledad. Consideraciones finales: a pesar del importante papel de las expresiones de espiritualidad y religiosidad para muchos miembros de la familia, no todos parecen beneficiarse de ellas. Los profesionales de la salud deben considerar estas expresiones en la construcción de la atención integral a la salud de los familiares.

RESUMO Objetivo: analisar as expressões da espiritualidade e da religiosidade de familiares de pessoas com uso abusivo ou dependente de substâncias psicoativas. Métodos: pesquisa exploratório-descritiva dialogando com o marco conceitual da espiritualidade e da religiosidade, realizada em ambulatório especializado no tratamento de drogas no sul do Brasil. Foram realizadas entrevistas semiestruturadas com 11 familiares de pacientes em tratamento, sendo analisadas pela análise de conteúdo. Resultados: foram agrupados em duas categorias: formas de expressão de práticas de espiritualidade e religiosidade e influência delas na vida dos familiares. A espiritualidade e religiosidade quase sempre servem como fator de proteção diante de sentimentos de angústia, conflitos e solidão. Considerações Finais: as expressões da espiritualidade e religiosidade têm papel importante para muitos familiares, no entanto nem todos parecem se beneficiar delas. Os profissionais de saúde devem considerar essas expressões na construção do cuidado integral em saúde dos familiares.

Covid-19 Impact on the Music Sector in Belo Horizonte (Minas Gerais, Brazil).

This article addresses the difficulties of musicians and measures taken by public and private authorities to mitigate the social impact of Covid-19 in the music sector of Belo Horizonte, capital city of the state of Minas Gerais, Brazil. These are preliminary results of a research developed by the research lab on Sound, Communication, Textualities and Sociability [ESCUTAS (in Portuguese)] at the Social Communication Department of the Federal University of Minas Gerais. This study has two perspectives. First, we surveyed public sources about Brazilian measures for the sector, as we are interested in verifying policies used by the private and public sectors, not only at the national level, but also at regional (state of Minas Gerais) and local (city of Belo Horizonte) levels. Second, we investigate the impact of the pandemic on the city's music sector, considering various categories of the profession such as composers, interpreters, arrangers, music teachers, DJs, among others. This work is part of a scenario of academic research and economic reports on the impacts of the pandemic in the music industry. More specifically, it aims to contribute to discussion on the effects of the social distance on livelihood of professionals of that area.

Evaluation of harm reduction strategies in the psychosocial care network / Evaluación de estrategias de reducción de daños en la red de atención psicosocial / Avaliação das estratégias de redução de danos na rede de atenção psicossocial

ABSTRACT Objective: to evaluate harm reduction strategies in the Psychosocial Care Network of a small city in the southern region of Brazil. Method: qualitative study, using the methodological assumptions of the Empowerment Evaluation. The research was carried out in the Psychosocial Care Network of a small city in Rio Grande do Sul, Brazil, from March to December 2017. Forty-two managers and workers of the psychosocial care network services and the intersectoral network for drug users participated in the study. Thematic analysis was used for data analysis. Results: the mission of the network under study involved a work proposal aimed at harm reduction. In the knowledge of the current situation, the integrated action of the harm reduction team to the other services in the network was identified and the need for greater understanding of the specifics of this work. Concerning the perspectives for the future of the network, efforts were made to strengthen harm reduction strategies that redeem the potential of individuals and investments in human and structural resources in damage reduction teams. Conclusion: the study presents support for the construction of harm reduction proposals integrated into the psychosocial care network, which can guide the prioritization of investments and improvements in the decision making of network managers and workers.

RESUMEN Objetivo: evaluar estrategias de reducción de daños en la Red de Atención Psicosocial de una ciudad del interior de la región sur de Brasil. Método: estudio cualitativo, utilizando los supuestos metodológicos de la Evaluación de Empoderamiento. La investigación se llevó a cabo en la Red de Atención Psicosocial de una pequeña ciudad de Rio Grande do Sul, Brasil, de marzo a diciembre de 2017. Participaron del estudio 42 gerentes y trabajadores incluidos en los servicios de la red de atención psicosocial y la red intersectorial para los consumidores de drogas. El análisis temático se utilizó para el análisis de datos. Resultados: la misión de la red en estudio involucró una propuesta de trabajo con perspectivas a la reducción de daños. En el Conocimiento de la situación actual, se identificó la acción integrada del equipo de reducción de daños con los demás servicios de la red y la necesidad de un mayor entendimiento de las especificidades de este trabajo. En las perspectivas de futuro de la red, se hicieron esfuerzos para fortalecer las estrategias de reducción de daños que rescatan el potencial de las personas y las inversiones en recursos humanos y estructurales en los equipos de reducción de daños. Conclusión: el estudio presenta subsidios para la construcción de propuestas de reducción de daños integradas a la red de atención psicosocial, que pueden orientar la priorización de inversiones y mejoras en la toma de decisiones de los gestores y trabajadores de la red.

RESUMO Objetivo: avaliar as estratégias de Redução de danos na Rede de Atenção Psicossocial de um município do interior da região Sul do Brasil. Método: estudo qualitativo, com a utilização dos pressupostos metodológicos da Avaliação de Empoderamento. A pesquisa foi realizada na Rede de Atenção Psicossocial de um município de pequeno porte do Rio Grande do Sul, Brasil, no período de março a dezembro de 2017. Participaram do estudo 42 gestores e trabalhadores inseridos nos serviços da rede de atenção psicossocial e da rede intersetorial ao usuário de drogas. Para análise dos dados utilizou-se a análise temática. Resultados: a missão da rede em estudo envolveu uma proposta de trabalho na perspectiva da redução de danos. No Conhecimento da situação atual identificou-se a atuação integrada da equipe da redução de danos aos demais serviços da rede e a necessidade de maior compreensão sobre as especificidades desse trabalho. Nas perspectivas para o futuro da rede buscou-se fortalecer estratégias de redução de danos que resgatem as potencialidades dos sujeitos e os investimentos em recursos humanos e estruturais nas equipes de Redução de danos. Conclusão: o estudo apresenta subsídios para a construção de propostas de redução de danos integradas à rede de atenção psicossocial, podendo orientar a priorização de investimentos e melhorias na tomada de decisão dos gestores e trabalhadores das redes.

Effect of ethanol pretreatment on melon convective drying.

The aim of this study was to evaluate the effectiveness of the use of ethanol, ultrasound and/or vacuum as a pretreatment to melon drying. Eight types of pretreatments were performed in which samples were immersed in ethanol solutions with different concentrations (50% and 100%) using four treatment conditions: immersion, immersion with ultrasound (US), with vacuum (VC) and with ultrasound and vacuum (USVC). Drying was performed at 60 °C and five different semi-theoretical drying mathematical models were examined to characterize the drying curves, and quality analyses were carried out. The condition that obtained the lower drying time was using the US pretreatment in 100% ethanol solution. Drying caused a diminution of bioactive compounds and influenced color parameters. However, the samples immersed in 50% ethanol solution and dried obtained minor losses of total phenolics, total carotenoids, and ascorbic acid contents.

The conceptions of health services managers about the network of psychosocial care for crack users

OBJETIVO: El objetivo de este estudio fue conocer las concepciones de los gerentes de servicios de salud sobre la red de atención psicosocial para usuarios de crack. MÉTODOS: encuesta cualitativa y evaluativa utilizando el marco de evaluación de cuarta generación. La encuesta se realizó en un centro de atención psicosocial para los consumidores de alcohol y drogas en un municipio del estado de Rio Grande do Sul, Brasil. Los datos se recopilaron de enero a mayo de 2013, a través de entrevistas guiadas utilizando el círculo dialéctico hermenéutico. RESULTADOS Y DISCUSIÓN: los gerentes revelaron sus concepciones sobre la colaboración entre sectores en la red de atención, reconociendo los servicios prestados por la red de atención psicosocial y la coordinación de esos servicios. También mostraron comprensión de la importancia de asociarse con mecanismos de otros sectores de la sociedad. CONCLUSIONES: los administradores municipales se han esforzado por construir una política de salud mental centrada en el usuario con coordinación entre sectores, abogando por los principios de la reforma psiquiátrica y la atención psicosocial.

OBJECTIVE: The objective of this study was to learn the conceptions of health services managers about the network of psychosocial care for crack users. METHODS: Qualitative and evaluative survey using the Fourth Generation Evaluation framework. The survey was performed at a center for psychosocial care for alcohol and drug abusers in a municipality of the State of Rio Grande do Sul, Brazil. Data were collected from January to May 2013, through guided interviews using the hermeneutic dialectical circle. RESULTS AND DISCUSSION: Managers revealed their conceptions about collaboration between sectors in the care network, recognizing the services provided by the psychosocial care network and the coordination of those services. They also displayed understanding of the importance of partnering with mechanisms from other sectors of society. CONCLUSIONS: Municipal managers have endeavored to build a user-focused mental health policy with coordination between sectors, advocating for the principles of psychiatric reform and psychosocial care.

Apoio material, família e cuidado as pessoas que utilizam crack / Material support, family and care towards crack users / Apoyo material, familia y cuidado a las personas que utilizan crack

Objetivo: Caracterizar o apoio material recebido por familiares no cuidado as pessoas que utilizam crack. Método: Estudo qualitativo, do tipo estudo de caso, realizado com três familiares, entre os meses de outubro à novembro de 2013 em uma cidade da região metropolitana de Porto Alegre/RS. Resultados: Identificou-se que o apoio material é sustentado pela presença das redes informais, ou seja, da própria família e colegas de trabalho. O recurso financeiro é fundamental para sobrevivência e manutenção das necessidades cotidianas dos familiares. Conclusão: As redes de apoio funcionam como estratégia no enfrentamento da situação do uso do crack dentro da família. Ressalta-se a importância de explorarmos essas redes no contexto dos serviços de saúde mental, com vistas a potencializar o cuidado para fora dos serviços.

Objective: The study's purpose has been to characterize the material support received by family members who take care of crack users. Methods: It is a case study with a qualitative approach, which was carried out with three relatives of crack users, starting from October to November 2013 in a city in the metropolitan region of Porto Alegre city, Rio Grande do Sul State. Results: It was identified that the material support is maintained by the presence of the informal networks, in other words, by the presence of the family and co-workers. The financial resource is essential for survival and maintenance of the daily needs of family members. Conclusion: Support networks work as a coping strategy considering the presence of crack users in the family. It must be underlined the importance of exploring these networks in the framework of mental health services, aiming to promote the care beyond the services

Objetivo: Caracterizar el apoyo material recibido por familiares en el cuidado de las personas que utilizan crack. Método: Estudio cualitativo, del tipo estudio de caso, realizado con tres familiares, entre los meses de octubre a noviembre de 2013 en una ciudad de la región metropolitana de Porto Alegre / RS. Resultados: Se identificó que el apoyo material es sostenido por la presencia de las redes informales, es decir, de la propia familia y compañeros de trabajo. El recurso financiero es fundamental para la supervivencia y el mantenimiento de las necesidades cotidianas de los familiares. Conclusión: Las redes de apoyo funcionan como estrategia en el enfrentamiento de la situación del uso del crack dentro de la familia. Se resalta la importancia de explorar esas redes en el contexto de los servicios de salud mental, con vistas a potenciar el cuidado fuera de los servicios

Potent nonopioid antinociceptive activity of telocinobufagin in models of acute pain in mice.

INTRODUCTION: In recent decades, several researches have been conducted in search of new analgesics that do not present the side effects of opioids. In this context, animal venoms contain natural painkillers that have been used for the development of new analgesics. OBJECTIVE: The aims of this study were to evaluate the antinociceptive effects of telocinobufagin (TCB), a bufadienolide isolated from Rhinella jimi venom, in murine acute pain models, and to verify the participation of the opioid system in these effects. METHODS: TCB was purified from R. jimi venom by high-performance liquid chromatography, and its structure was confirmed by spectrometric techniques. TCB was administered intraperitoneally (i.p.) (0.062, 0.125, 0.25, 0.5, and 1 mg·kg-1) and orally (p.o.) (0.625, 1.125, 2.5, 5, and 10 mg·kg-1) in mice, which were then subjected to pain tests: acetic acid-induced writhing, formalin, tail-flick, and hot-plate. Involvement of the opioid system in TCB action was evaluated by naloxone i.p. injected (2.5 mg·kg-1) 20 minutes before TCB administration. In addition, the TCB action on the µ, δ, and κ opioid receptors was performed by radioligand binding assays. RESULTS: In all the tests used, TCB showed dose-dependent antinociceptive activity with more than 90% inhibition of the nociceptive responses at the doses of 1 mg·kg-1 (i.p.) and 10 mg·kg-1 (p.o.). Naloxone did not alter the effect of TCB. In addition, TCB did not act on the µ, δ, and κ opioid receptors. CONCLUSION: The results suggest that TCB may represent a novel potential nonopioid therapeutic analgesic for treatment of acute pains.

Adequação nutricional de pacientes em unidade de terapia intensiva segundo indicadores de qualidade emterapia nutricional / Nutritional adequacy of patients in intensive care unit by quality indicators in nutrition therapy

Introdução: Diversas condições interferem na terapia nutricional em pacientes gravemente doentes. Pacientes em estado crítico que não recebem a terapia nutricional adequada são mais suscetíveis a complicações infecciosas e podem apresentar maior tempo de ventilação mecânica, maior permanência na unidade de terapia intensiva e maiores taxas de mortalidade. Objetivo: Avaliar a adequação da terapia nutricional enteral nas unidades de terapia intensiva de um hospital universitário de Pernambuco. Metodologia: Estudo prospectivo observacional realizado em pacientes adultos e idosos, de ambos os sexos, internados nas unidades de terpaia intensiva em um hospital universitário de Pernambuco. A adequação nutricional foi estimada através da relação percentual entre o volume de dieta prescrito e o administrado, onde foi considerado como ideal uma porcentagem maior que 80%. Com vistas a conhecer os possíveis fatores associados à inadequação nutricional, foi comparado o grupo de pacientes que recebeu < 80% do volume prescrito ao que recebeu ≥ 80%. Aplicaram-se os indicadores de qualidade em terapia nutricional. Resultados: A amostra foi composta por 71 pacientes, 57,7% homens e 60,6% idosos. Houve associação entre a adequação nutricional e melhor desfecho clínico (p=0,004) e nutrição enteral precoce (p=0,047). A inadequação nutricional associou-se ao uso de droga vasoativa (p=0,027) e presença de jejum > 24 horas (p<0,001). As causas mais frequentemente relacionadas com a interrupção da dieta foram as complicações gastrointestinais. Os indicadores: frequência da estimativa das necessidades nutricionais, diarreia, hipoglicemia e saída inadvertida da sonda nasoenteral ficaram dentro da meta estabelecida. Conclusão: A oferta inferior a 80% das necessidades nutricionais se associou a um pior desfecho clínico, sendo influenciada pela nutrição enteral tardia, uso de drogas vasoativas e jejum maior que 24 horas. A aplicação dos indicadores de qualidade em terapia nutricional favoreceu uma melhor adequação nutricional aos pacientes gravemente doentes

Introduction: Several conditions interfere with nutritional therapy in critically ill patients. Critically ill patients who do not receive adequate nutritional therapy are more susceptible to infectious complications and may have longer mechanical ventilation, longer intensive care unit stay, and higher mortality rates. Objective: To evaluate the adequacy of enteral nutritional therapy in the intensive care unit of a university hospital in Pernambuco. Methods: Prospective observational study conducted in adults and elderly patients, of both sexes, in the intensive care unit of a University Hospital of Pernambuco. The adequacy of the prescribed diet and the volume administered was estimated by the percentage ratio, which was regarded as ideal a higher percentage than 80%. In order to know the possible factors associated with nutritional inadequacy, the group of patients was compared to received <80% of the prescribed amount, the group of patients who received ≥ 80%. They applied to the quality indicators. Results: The sample consisted of 71 patients, 57.7% men and 60.6% elderly. There was an association between nutritional adequacy and better clinical outcome (p = 0.004) and enteral nutrition early (p = 0.047). The nutritional inadequacy was associated with the use of vasoactive drugs (p = 0.027) and the presence of fasting> 24 hours (p <0.001). The causes most frequently related to the discontinuation of the diet were gastrointestinal complications. Indicators: frequency of the estimated nutritional needs, diarrhea, hypoglycemia and inadvertent output of nasogastric tube were within the established target. Conclusion: The offer less than 80% of nutritional requirements is associated with a poor clinical outcome and being influenced by the late enteral nutrition, use of vasoactive drugs and greater than 24 hours fasting. The application of quality indicators in nutritional therapy promotes better nutritional adequacy to intensive care unit patients

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[Empowerment evaluation: theoretical and methodological considerations applied to the health area]. / Avaliação de empoderamento: considerações teórico-metodológicas aplicadas ao campo da saúde.

The objective of this article is to discuss the empowerment evaluation as a theoretical and methodological framework and its applications to the health area. This is a theoretical article that presents the conceptual and methodological aspects and the principles of the empowerment evaluation. This evaluation is regarded as an approach that allows the participation of interest groups in the process, in order to improve the qualification and transformation of the knowledge and practices of the context evaluated. In the health area, the possible articulations between this framework and the complexity of the practices are discussed, aiming to increase the sense of belonging and responsibility of the participants in the evaluation process. Empowerment evaluation is a viable and powerful theoretical and methodological alternative in the health area, which, in addition to producing knowledge applied to the reality of interest groups, also provides a better understanding of work processes and institutional arrangements in the field of health management and health care.

O objetivo do artigo é discutir a avaliação de empoderamento como referencial teórico-metodológico e suas aplicações ao campo da saúde. Trata-se de um artigo teórico que se propõe a apresentar as raízes conceituais, metodológicas e princípios da avaliação de empoderamento. Considera-se essa avaliação como uma perspectiva que enseja a participação dos grupos de interesse no processo, de modo a auxiliar na qualificação e transformação dos saberes e das práticas do contexto avaliado. No campo da saúde, discutem-se as articulações possíveis entre o referencial e a complexidade das práticas, visando a aumentar a sensação de pertencimento e responsabilidade dos participantes pelo processo avaliativo. A avaliação de empoderamento é uma alternativa teórica e metodológica viável e potente no campo da saúde, que, além de produzir conhecimento aplicado à realidade dos grupos de interesse, também proporciona maior compreensão sobre os processos de trabalho e os diversos arranjos institucionais no campo da gestão e do cuidado em saúde.

El objetivo del artículo es discutir la evaluación de empoderamiento como marco de referencia teórico metodológico y sus aplicaciones al campo de la salud. Se trata de un artículo teórico que se propone a presentar las raíces conceptuales, metodológicas y principios de la evaluación de empoderamiento. Se considera dicha evaluación como una perspectiva que anhela la participación de los grupos de interés en el proceso, de modo auxiliar en la cualificación y transformación de los saberes y las prácticas del contexto valorado. En el campo de la salud, se discuten las articulaciones posibles entre el marco de referencia y la complejidad de las prácticas, con vistas a incrementar la sensación de pertenencia y responsabilidad de los participantes por el proceso evaluativo. La evaluación de empoderamiento es una alternativa teórica y metodológica factible y potente en el campo sanitario, la que, más allá de producir conocimiento aplicado a la realidad de los grupos de interés, también proporciona mayor comprensión acerca de los procesos laborales y los distintos arreglos institucionales en el campo de la gestión y el cuidado sanitarios.

Serial Palliative Performance Scale Assessment in a University General Hospital: A Pilot Study.

BACKGROUND: Serial Palliative Performance Scale (PPS) assessments may predict functional decline and prognosis in cancer and noncancer patients and help with end-of-life decision making. OBJECTIVE: To evaluate the functional status of using serial PPS assessments of patients being assisted in collaboration with the palliative care team (PCT). DESIGN: Prospective cohort pilot study. MEASUREMENTS: The sample consisted of 64 cancer and noncancer inpatients being assisted in collaboration with the PCT during the period from 2012 to 2016 (included 12 months). Patients' PPS scores were assessed in three sequential stages: prehospital, first PCT assessment, and outcome (discharge, transference to another unit or death). Functional performance was classified in categories as stable (PPS scores between 70% and 100%), transitional (PPS scores between 40% and 60%), and end of life (PPS scores between 10% and 30%). RESULTS: The mean PPS score during the three assessment stages (respectively, 60.5%, 38.9%, and 25.9%) was significantly different (p < 0.001). Cancer patients had higher PPS scores than noncancer patients; however, both groups exhibited a functional decline along the hospital stay. In both groups there was a negative correlation between the time frame between the different assessment stages and PPS scores (respectively, Pearson -0.4 and -0.6; p < 0.01). The survival curve of the first palliative assessment stage demonstrated earlier death in patients in the end-of-life category. CONCLUSION: Serial PPS assessments are feasible and predicted functional decline in cancer and noncancer patients in this sample. Cancer patients exhibited higher initial functional scores but both cancer and noncancer patients declined in functionality along hospitalization. Earlier deaths occurred in the terminal PPS category than in the transitional PPS category.

Avaliação de empoderamento: considerações teórico-metodológicas aplicadas ao campo da saúde / Empowerment evaluation: theoretical and methodological considerations applied to the health area / Evaluación de empoderamiento: consideraciones teóricas y metodológicas aplicadas al campo de la salud

RESUMO O objetivo do artigo é discutir a avaliação de empoderamento como referencial teórico-metodológico e suas aplicações ao campo da saúde. Trata-se de um artigo teórico que se propõe a apresentar as raízes conceituais, metodológicas e princípios da avaliação de empoderamento. Considera-se essa avaliação como uma perspectiva que enseja a participação dos grupos de interesse no processo, de modo a auxiliar na qualificação e transformação dos saberes e das práticas do contexto avaliado. No campo da saúde, discutem-se as articulações possíveis entre o referencial e a complexidade das práticas, visando a aumentar a sensação de pertencimento e responsabilidade dos participantes pelo processo avaliativo. A avaliação de empoderamento é uma alternativa teórica e metodológica viável e potente no campo da saúde, que, além de produzir conhecimento aplicado à realidade dos grupos de interesse, também proporciona maior compreensão sobre os processos de trabalho e os diversos arranjos institucionais no campo da gestão e do cuidado em saúde.

ABSTRACT The objective of this article is to discuss the empowerment evaluation as a theoretical and methodological framework and its applications to the health area. This is a theoretical article that presents the conceptual and methodological aspects and the principles of the empowerment evaluation. This evaluation is regarded as an approach that allows the participation of interest groups in the process, in order to improve the qualification and transformation of the knowledge and practices of the context evaluated. In the health area, the possible articulations between this framework and the complexity of the practices are discussed, aiming to increase the sense of belonging and responsibility of the participants in the evaluation process. Empowerment evaluation is a viable and powerful theoretical and methodological alternative in the health area, which, in addition to producing knowledge applied to the reality of interest groups, also provides a better understanding of work processes and institutional arrangements in the field of health management and health care.

RESUMEN El objetivo del artículo es discutir la evaluación de empoderamiento como marco de referencia teórico metodológico y sus aplicaciones al campo de la salud. Se trata de un artículo teórico que se propone a presentar las raíces conceptuales, metodológicas y principios de la evaluación de empoderamiento. Se considera dicha evaluación como una perspectiva que anhela la participación de los grupos de interés en el proceso, de modo auxiliar en la cualificación y transformación de los saberes y las prácticas del contexto valorado. En el campo de la salud, se discuten las articulaciones posibles entre el marco de referencia y la complejidad de las prácticas, con vistas a incrementar la sensación de pertenencia y responsabilidad de los participantes por el proceso evaluativo. La evaluación de empoderamiento es una alternativa teórica y metodológica factible y potente en el campo sanitario, la que, más allá de producir conocimiento aplicado a la realidad de los grupos de interés, también proporciona mayor comprensión acerca de los procesos laborales y los distintos arreglos institucionales en el campo de la gestión y el cuidado sanitarios.

Excesso de peso e obesidade em portadores de doença pulmonar obstrutiva crônica / Overweight and obesity in patients with chronic obstructive pulmonary disease

Objetivo: Definir o perfil epidemiológico do excesso de peso/obesidade e caracterizar as principais alterações antropométricas em pacientes com doença pulmonar obstrutiva crônica (DPOC) atendidos ambulatorialmente. Método: Estudo transversal, tipo série de casos, realizado no Ambulatório de Pneumologia do Hospital das Clínicas/UFPE. Foram coletados dados socioeconômicos, culturais e comportamentais. Para avaliação nutricional, foram coletados dados de peso, altura, índice de massa corporal (IMC), circunferências da cintura (CC), braço (CB) e quadril (CQ), e obtidas a relação cintura-estatura (RCEst) e a relação cintura-quadril (RCQ). Resultados: Foram obtidos 54 pacientes elegíveis com o seguinte perfil: faixa etária maior de 60 anos (68,5%), não brancos (75,9%), sexo masculino (68,5%), residentes no interior do estado (83,4%), casados/união estável (51,8%), baixa escolaridade (64,8%), sem ocupação (75,9%), renda ≤ 1 salário mínimo (66,6%), tabagistas (11,1%), ex-tabagistas (81,5%), sedentá- rios (66,7%), sobrepeso/obesidade (50%), CC elevada (57,41%), RCQ elevada (51,86%), RCEst elevada (83,34%) e 38,8% na faixa da desnutrição em relação à CB. Conclusão: O excesso de peso/obesidade é bastante prevalente em pacientes com DPOC atendidos ambulatorialmente. Foi observado que, de forma paradoxal, o excesso de peso foi acompanhado de redução da massa magra, característica típica da afecção.

Objective: To define the epidemiological profile of overweight/obesity and characterize the major anthropometric changes in chronic obstructive pulmonary disease (COPD) outpatients. Methods: Study of case series cross-sectional performed in Nutrition Outpatient/ Pulmonology Clinic of Clinical Hospital at Federal University of Pernambuco. Patients were evaluated by collecting socio-economic, cultural and behavioral data. For nutritional assessment, it was collected weight, height, body mass index (BMI), waist circumference (WC), arm circumference (AC) and hip circumference (HC), and it was calculated the waist-height ratio (WHtR) and waist-hip ratio (WHR). Results: It was obtained 54 eligible patients with the following profile: age higher than 60 years (68.5%), non-white (75.9%), male (68.5%), living within the state (83.4%), married/ stable union (51.8%), low education (64.8%), unemployed (75.9%), income ≤ 1 minimum wage (66.6%), smokers (11.1%), ex-smokers (81.5%), sedentary (66.7%), overweight/obesity (50%), high WC (57.41%), high WHR (51.86%), WHtR (83.34%) and 38.8% of malnutrition regarding to AB. Conclusion: Overweight/obesity is highly prevalent in patients with COPD outpatients. It was observed that, paradoxically, excess weight was accompanied by reduced lean body mass, a typical characteristic of the disease.

Perfis metabólico e nutricional como preditores da síndrome da apneia obstrutiva do sono / Metabolic and nutritional status as predictors of obstructive sleep apnea syndrome

RESUMO Objetivo: Correlacionar os perfis metabólico e nutricional com a presença e gravidade da síndrome da apneia obstrutiva do sono. Métodos: Estudo transversal com pacientes adultos e idosos, de ambos os sexos, atendidos no Laboratório do Sono e Coração do Pronto Socorro Cardiológico Universitário de Pernambuco, entre junho e setembro de 2014. Os pacientes se submeteram à polissonografia, à bioimpedância elétrica e a aferições antropométricas. Foram verificadas a presença da síndrome metabólica e outras morbidades. Resultados: A amostra total foi constituída por 50 pacientes, com idade média de 57,52±9,80 anos, sendo que 94% receberam diagnóstico de síndrome da apneia obstrutiva do sono e 74% possuíam síndrome metabólica. As seguintes médias foram obtidas: índice de massa corporal (31,54±5,82 kg/m2); circunferência do pescoço (39,14±4,33 cm); circunferência da cintura (106,72±11,22 cm); diâmetro abdominal sagital (23,00 cm [21,00-24,00]). O índice de massa corporal, a circunferência da cintura e o diâmetro abdominal sagital apresentaram valores mais elevados (p<0,05) entre os pacientes com síndrome da apneia obstrutiva do sono grave, quando comparados aqueles com a forma leve. O diâmetro abdominal sagital apresentou moderada correlação com o índice de apneia e hipopneia e a gordura corporal apresentou fraca correlação. Conclusão: A obesidade, a circunferência do pescoço, o diâmetro abdominal sagital e a síndrome metabólica tiveram associação positiva com a gravidade da síndrome da apneia obstrutiva do sono. Dentre os parâmetros antropométricos avaliados, o diâmetro abdominal sagital mostrou ser o mais adequado preditor para avaliar a presença e gravidade da síndrome da apneia obstrutiva do sono.

ABSTRACT Objective: To compare metabolic and nutritional profiles with the presence and severity of obstructive sleep apnea syndrome. Methods: This cross-sectional study included male and female adults and older adults treated at the Sleep and Heart Laboratory of Pernambuco Cardiologic Emergency Medical Services between June and September 2014. Patients underwent polysomnography, bioelectrical impedance analysis, and anthropometric measurements. Presence of the metabolic syndrome and other morbidities was investigated. Results: The sample consisted of 50 patients with a mean age of 57.52±9.80 years, of which 94% were diagnosed with obstructive sleep apnea syndrome, and 74% had the metabolic syndrome. Other mean sample characteristics were: body mass index (31.54±5.82 kg/m2); neck circumference (39.14±4.33 cm); waist circumference (106.72±22.11 cm); sagittal abdominal diameter (23.00 cm [21.00-24.00]). Patients with severe obstructive sleep apnea syndrome had higher body mass index, waist circumference, and sagittal abdominal diameter (p<0.05) than those with mild condition. Sagittal abdominal diameter was correlated moderately with the apnea-hypopnea index and mildly with body fat. Conclusion: Obesity, neck circumference, and the metabolic syndrome had a positive association with obstructive sleep apnea syndrome severity. Of the study anthropometric parameters, sagittal abdominal diameter was the most suitable predictor of presence and severity of obstructive sleep apnea syndrome.

[Not Available]. / Asociación de los indicadores antropométricos y de composición corporal en la predicción de la resistencia a la insulina en pacientes con enfermedad de las arterias coronarias.

Introducción: en los últimos años la importancia de identificar la resistencia a la insulina (RI) en pacientes con enfermedades cardiovasculares isquémicas viene siendo debatida. Métodos alternativos, como los indicadores antropométricos y de composición corporal, han sido señalados como una buena opción y contribuyen para identificar anomalías metabólicas y prevenir complicaciones.Objetivo: asociar indicadores antropométricos y de composición corporal como predictores de la resistencia a la insulina (RI) en pacientes con enfermedad de las arterias coronarias.Métodos: estudio transversal realizado en el hospital de referencia cardiológica de Pernambuco, en el periodo de junio a septiembre de 2014, con pacientes adultos y ancianos hospitalizados, de ambos sexos. Se verificaron los siguientes parámetros: estilo de vida, la presencia del síndrome metabólico (SM) y otras comorbilidades. Se analizó la RI por el cálculo del HOMA-IR. Los pacientes se sometieron a la impedancia bioeléctrica (BIA) y a las verificaciones antropométricas.Resultados: la muestra fue constituida por 75 pacientes con edad media de 63,75 ± 12,43 años, con un 64% de ancianos. Se encontró el diagnóstico de SM en el 65,3% de los pacientes, el 81,3% de sedentarios y el 37,4% con exceso de peso. Se diagnosticó la RI en el 28% de los pacientes. Se observó correlación entre el HOMA-IR y el diámetro abdominal sagital (DAS) (r = 0,476; p = 0,016), el índice de masa corporal (r = 0,233; p = 0,040) y el porcentual de grasa corporal (r = 0,276; p = 0,016).Conclusión: el DAS fue el indicador antropométrico que presentó mejor correlación con la RI en pacientes con enfermedad de las arterias coronarias hospitalizados.